Middle Aged Woman with Sudden Onset of Hyperpigmented Patch

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© Springer Nature Switzerland AG 2020
S. Kothiwala et al. (eds.)Clinical Cases in Disorders of MelanocytesClinical Cases in Dermatologyhttps://doi.org/10.1007/978-3-030-22757-9_10



10. A Middle Aged Woman with Sudden Onset of Hyperpigmented Patch



Md. Zeeshan1  


(1)
Patna Medical College and Hospital, Patna, India

 



 

Md. Zeeshan


Keywords

Postinflammatory hyperpigmentationMelanosisPostinflammatory hypopigmentationChemical peelingKligman’s formula


A 38-year-old woman with Fitzpatrick skin type IV presented to the outpatient clinic with asymptomatic, non-progressive brown patchy discoloration of face for past 2 months (Fig. 10.1). She was having melasma for which she underwent chemical peeling at a salon by a beautician. During the chemical peeling, she experienced extreme burning sensation, followed by appearance of dusky-red patches. These dusky-red patches on healing left dark brown to black patches. There is no history of similar lesions elsewhere. Rest of the history was non-contributory.

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Figure 10.1

Dark brown macules and patches on the face in a lady with melasma. Note linear shaped hyperpigmentation in pre-auricular area. (Courtesy: Dr. Piyush Kumar)


Cutaneous examination revealed multiple, coalescing, ill-defined brown-dark coloured macules and patches on the face involving whole cheek and zygotemporal area with sparing of peri-orbital area. Based on the case description and the photograph, what is your diagnosis?


  1. 1.

    Post-inflammatory hyperpigmentation


     

  2. 2.

    Lichen planus pigmentosus


     

  3. 3.

    Erythema dyschromicum perstans


     

  4. 4.

    Macular amyloidosis


     

Diagnosis






  • Postinflammatory hyperpigmentation (PIH)


Discussion


Postinflammatory hyperpigmentation (PIH) is a reactive hypermelanosis that develops following cutaneous inflammation and occurs more commonly in individuals with darker skin (Fitzpatrick skin type IV, and V) [1]. Common causes of PIH include various inflammatory or infectious dermatoses as well as external insults to the skin, such as burn injuries and dermatologic procedures and have been summarized in Table 10.1 [2].


Table 10.1

Common dermatologic conditions that can cause postinflammatory hyperpigmentation
















•  Inflammatory dermatoses


Acne/acneiform eruption


Pseudofolliculitis barbae


Eczema


Atopic dermatitis


Irritant contact dermatitis


Allergic contact dermatitis


Pigmented contact dermatitis


Photoallergic contact dermatitis


Lichen simplex chronicus


Insect bites


Papulosquamous disorders


Psoriasis


Pityriasis rosea


Lichen planus/lichen planus pigmentosus


Lichenoid dermatitis


Erythema dyschromicum perstans


Connective tissue disease


Lupus erythematosus


Vasculitis


Morphea/scleroderma


Atrophoderma of Pasini and Pierini


Vesiculobullous disorders


Pemphigus


Bullous pemphigoid


Dermatitis herpetiformis


•  Infections


Impetigo


Viral exanthems


Chicken pox


Herpes zoster


Dermatophytosis


Syphilis


Pinta


Onchocerciasis


•  Cutaneous adverse drug reactions


Phototoxic dermatitis


Morbilliform eruption


Erythema multiforme


Fixed drug eruption


Stevens-Johnson syndrome/Toxic epidermal necrolysis


Lichenoid drug eruption


•  Dermatological procedures


Chemical peel


Dermabrasion


Cryotherapy


Laser treatment


Intense pulsed light treatment


• Miscellaneous


Mycosis fungoides


Neurotic excoriation


Sunburn


Trauma


Friction

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Mar 23, 2021 | Posted by in Dermatology | Comments Off on Middle Aged Woman with Sudden Onset of Hyperpigmented Patch

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